The effect of the retinoids such as retinoic acid (vitamin A acid) and retinol (vitamin A alcohol) is complex. Retinoic acid became the first widely used product for skin renewal. Retinol is much weaker at skin renewal but may have potent actions on decreasing excessive breakdown of collagen and elastin in the skin, a process that become increasing excessive as we age.

Retinoic Acid (Tretinoin, Retin-A, Renova)

Retinoic acid or tretinoin is the acidic version of vitamin A or retinol. It is the only product that has been approved by FDA for reversing aging effects on skin, reducing wrinkles and mottled darkened spots and smoothing the skin. It reduces skin oil by shrinking sebaceous glands and unclogging hair follicles. It also increases epidermal thickness and stimulates deposition of new collagen across the skin1. Retinoic acid is sold under brand names such as Retin-A and Renova by Ortho Pharmaceutical Corp. of Raritan, N.J., a division of Johnson and Johnson. It is available by prescription only.

Skin Renewal Studies with Retinoic Acid

The typical strength of topical tretinoin creams is 0.025 - 0.1 percent. With tretinoin (Retin A, Renova) more is not necessarily better. One study has found that 0.025 percent tretinoin may be as effective as 0.05 or 0.1 percent, but with lower incidence of skin irritation. For those with sensitive skin, 0.025% may be the optimal strength. According to the studies, improvement on tretinoin (Retin A, Renova) may continue for up to a year of continued use.

Jonathan S. Weiss, M.D. and colleagues described a l6-week, double-blinded study of retinoic acid cream to treat sun-related skin aging in 30 patients. All 30 patients showed statistically significant improvements in sun-related skin damage on their retinoic acid-treated forearms, compared with forearms treated with a drug-free cream. Improvement was also seen in l4 of the l5 patients who used tretinoin on their faces2.

In other double-blind controlled trials lasting up to 48 weeks, signs of improvement were observed in 68-79% of treated subjects (reduction in fine wrinkles and mottled hyperpigmentation, and smoothing of rough facial skin). Improvement was also seen in the group using the vehicle alone, but was judged to be only about half the improvement seen in the retinoic acid group. Patient self-evaluation correlated well with physician evaluation. Examination of skin biopsy specimens showed histologic improvement, including increased skin thickness and compaction and decreased pigment content3.

How to Use Retin-A and Copper-Peptides Together

Retin-A can be used along with Skin Biology's copper-peptide products. Here is our recommendation:

• If you are using a copper-peptide oil-free serum (or liquid) version: Apply the copper-peptides first then your Retin-A cream can be applied lightly on top.

• If you are using a copper-peptide cream:The cream versions of copper-peptides with their fatty molecules may actually block the Retin-A uptake. So it may be best to first apply your Retin-A product, then use SRCPs lightly on top.

We can advise clients that Retin-A, depending on the percentage prescribed to them, might increase the uptake of copper-peptides applied directly on top. So our copper-peptides may feel stronger when used along with Retin-A.

The Irritation Problem with Retinoic Acid

Dermatologists tend to underplay the irritation effects of retinoic acid. Side effects from topical retinoic acid include mild to severe irritation, temporary peeling, redness, and blistering, and a permanent increase in sun sensitivity. The drug should not be used by anyone receiving photosensitizing drugs (thiazides, tetracyclines, fluoroquinolones, phenothiazines, sulfonamides).

The skin irritation is a major drawback with retinoic acid. It can can become very severe but should not be treated by cortisone or corticosteroids. Protect & Restore Cream or CP Serum often effectively manage the irritation produced by retinoic acid.

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Are New Retin-A Formulations Better?

Many new versions of retinoic acid are now appearing on the market and sold as great improvements over Retin-A. This is because the patents on Retin-A are expiring which will sharply drop the price. If retinoic acid becomes an over the counter product available on the shelf in drugstore, the price will drop to $1 to $2 per tube. The new retinoic acid products appearing on the market are only marginally better (if at all) than the original Retin-A and are being introduced to keep a high price on the product.

Lord Frederick Leighton - Venus Disrobing for the Bath, 1866

Retinol (Vitamin A Alcohol)

This is ordinary vitamin A. Because pure retinol is unstable, the ester forms of vitamin A are used. These are molecules such as retinyl palmitate and retinyl proprionate but they all work similarly. Cosmetic companies try to say different forms have very different actions but there is little basis for these claims.

Retinol is added to moisturizers or oils and serves as a humectant by attracting water to plump up the epidermis. A small amount of topical retinol also is converted in the skin to retinoic acid, the biologically active agent for skin renewal. Retinol does markedly stimulate skin repair in immune-deficient rats and rabbits. Because the human immune system decreases in potency with age, retinol may help skin repair in humans over age 45 or when declines in immune system effectiveness first become significant.

Retinol decreases excessive breakdown of collagen and elastin in the skin. However, it has long been established that excessive retinol on the skin can cause acne in younger persons. While there is no hard-and-fast age when retinol ceases to cause acne, in general, those under 25 are more likely to develop retinol-produced acne, while in most people over 45, retinol appears to have very positive actions on skin renewal.

The use of retinol in skin cream is safe if used in moderation. A skin cream with 0.1% retinol would contain 500 units of retinol per gram of cream. For example, if you used 2 grams of such a cream per day, and if all the retinol were taken into your body, this would only be 1,000 units of vitamin A daily. The daily safe dose of retinol is 10,000 units but liver damage has been reported at 21,600 units per day.

Skin Exfoliation Methods

Dermabrasion